Acknowledgments

An Ecological Approach to Family Intervention in Early Childhood:Embedding Services in WICThomas J. DishionUniversity of Oregon&Child and Family CenterPresented at:Intervening Early Conference, Sept 18-19, 2007

Acknowledgments Thanks to: NIDA Support Research Colleagues Daniel Shaw Melvin Wilson Frances Gardner Early Steps Project Staff Early Steps Families

Challenges in Providing Child and Family Mental Health Services to the Poor. 1-Many services are paid by personal insurance and cover only DSM disorders. 2-State funded services are often poorly supported, ineffective, not research based, and in some cases possibly iatrogenic. 3-Solution: Embed affordable and effective interventions in agencies that have wide access and repeated exposure to children and families (Hoagwood & Koretz, 1996)

Three Goals of this Talk. 1-Provide an overview of the ecological approach to family intervention and treatment (ecoFIT). 2-Review findings from a pilot study applying the ecoFIT to high risk young families participating in WIC services. 3 - Review initial findings from a multi site outcome study applying the ecoFIT to high risk young families participating in WIC services.

What is an ecological approach to child and family therapy?

The Ecology of Self Regulation Entrained Biosocial Response Patterns Relationship Dynamics Behavior Settings Relationship Dynamics Schools Home Child Adjustment Spouses Peers Siblings Teachers Parents Neighborhood

Six Features of An Ecological Approach to Child and Family Interventions (Eco FIT)(From Dishion & Stormshak, 2006) An ecologial approach…. • is based on an empirically based model of child and adolescent problem behavior; • is family-centered, addressing adult leadership and support in the change process; • is assessment driven, with decisions regarding intervention needs following careful assessments; • targets social interactions with parents and peers to make long lasting change; • addresses client motivation to change as a core component; • utilizes a health maintenance model delivered in service settings that involve children and families;

A Developmental Model for the Influence of Family and Peers on Child Adjustment (from Dishion & Patterson, 2006) Peer Network Coalitions Parent Guided Socialization Parent-Child Relationship Early Middle Childhood Childhood Adolescence

Four nonspecific factors which undermine intervention effectiveness(from Dishion & Stormshak, in press): A Broad Overview of Intervention Outcome Literature (Dishion & Stormshak, 2007) Potentially Harmful — Beneficial + Child Self Regulation Adult Involvement Positive Relationships Behavior Management Skills Unsupervised Peer Groups Peer Contagion

Research on the Effectiveness Interventions that Target Parenting

Question Pre-contemplation Explore Ambivalence Develop Discrepancy Contemplation Process of Change Maintenance Offer Perspective Support Self-efficacy Preparation Action Avoid Arguments Advise ES Training, March 2004

Interventions that Address Motivation to Change

An Overview of the ecoFIT Strategy (Dishion & Stormshak, 2007)

Service Systems Affecting Mental Health of Children and Adolescents Developmental Stage Early Childhood Childhood Early Adolescence Adolescence Public School Setting Community Programs: Treatment and Rehabilitation WIC, Preschools ORI, May 2002

Early Steps Pilot Project Research Design (N=120) W.I.C. Services Screening Assessment Random Assignment FCU Control

Three Year Effects on Parent Report Problem Behavior in Early Childhood.(Shaw, Dishion, Supplee & Gardner 2006) Effect size at age 4 = .45 sd

Three Year Effects on Observations of Parent Monitoring in Early Childhood(Shaw, Dishion et al, 2006) Effect size at age 4 = .48 sd

Early Steps Multi-site Research Design (N=731: Eugene, Pittsburgh & Charlottesville) W.I.C. Services Screening Assessment Random Assignment FCU Control

Design of the Early Steps Multi Site Project (Dishion, Gardner, Shaw & Wilson) • Study Sample: 731 WIC Families with Toddlers • Design: Longitudinal follow-up age 2 to 5 • Retention: 89% from ages 2 to 3 • Ethnicity: 50.1% European American (n=366) • 27.9% African American (n=204) • 13.4% Hispanic/Latino (n=98) • 8.6% Other (n=63) • Gender: 50.5% Male (n=369) • 49.5% Female (n=362)

Primary Caregiver ratings on Problem Behavior (Dishion, Shaw et al, under review) Typically Developing High Risk 18 17 16 15 14 13 12 11 18 17 16 15 14 13 12 11 C I C Intensity T scores C I C I I Age 2 Age 4: Age 2 Age 4 Intervention Effect (.16) I = Intervention C = Control

Intervention Outcomes on Direct Observations of Parent Positive Reinforcement

Changes in Observed Parenting Mediates Reductions in Children’s Problem Behavior. Age 2 Ey. Age 3 Ey. Age 4 Ey. Int PB Slope PB -11* Proactive Ratings Proactive Ratings Observed Parent PBS Age 3 Observed Parent PBS Age 2 .88* Parent Invol. Ratings Parent Invol. Ratings Observed Pos. Rein Observed Pos. Rein Observed Int. Eng. Observed Int. Eng. (from Dishion, Shaw, Connell et al, under review)

Concluding Comments. 1 Embedding family interventions within agencies such as WIC is feasible and cost effective (average # hours=3 for toddlers); 2 The families that are the most at risk are the most likely to engage in the FCU (single parents, teen mothers, low education, low income) 3 Although effect sizes are small, they are enduring overtime 4 Future work on the ecoFIT model will focus on improving engagement in skill-building interventions that focus on parents ‘positive behavior support’.

For more information: tomd@uoregon.edu http://cfc.uoregon.edu Also See: Dishion, T. & Stormshak, E. (2007). Intervening in Children’s Lives: An Ecological, Family-centered Approach. APA: Washington DC

Acknowledgments